Pediatric Coding Alert

Although there arent many major changes for pediatricians in CPT Codes 2001, there are a few minor ones that are important to consider for correct coding. And some are expected to improve reimbursement once insurance companies adopt them into their systems.

The big changes in CPT 2001 for pediatricians involve vaccines and critical care. Smaller changes affect nutrition therapy, tube placement and testing. These relate to services provided in a pediatric practice, and the codes will allow more equitable reimbursement.

Medical Nutrition Therapy

Although not for use by a pediatrician, three new codes can be used by a nurse who counsels a child regarding eating behavior:

97802 medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes;

97803 ... re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes; and

97804 ... group (2 or more individual[s]), each 30 minutes.

Tube Placement

Sometimes in pediatrics, especially with special-needs children, naso- or oro-gastric tubes must be placed directly by a physician. Although a nurse usually performs this procedure (and therefore it may not be billed separately), the physician occasionally must place the tube. Until the 2001 CPT changes, there was not a code for this service if performed by a physician. Now, when a physician places the tube it is a separately billable service and should be coded 43752 (naso- or oro-gastric tube placement, necessitating physicians skill) according to CPT 2001.

Code 43752, however, cannot be used with neonatal intensive care codes (99295-99298) and critical care codes (99291-99292) because CPT bundles the tube placement into those codes.

New Testing Codes

Pediatricians may test children for pinworms using the tape test. This involves placing a piece of adhesive tape against the anus, removing it, and viewing the tape under the microscope for evidence of pinworms. Pediatricians have not had a way to charge for this test until now with the introduction of 87172 (pinworm exam [e.g., cellophane tape prep]).

When testing for bilirubin, pediatricians often use a machine that measures bilirubin transcutaneously and eliminates the need to obtain blood from a newborn. The machine costs about $5,000. The new code for this test is 88400 (bilirubin, total, transcutaneous). Now this test is usually done in hospitals, which can afford the machine because they have so many newborns to test. Some large pediatric practices may find it useful as well. Because bilirubin testing is mainly restricted to the first two or three days of life, office-based pediatric practices likely will not use this code widely.

Note: Charles Schulte, MD, FAAP; Joel Bradley, MD, FAAP; and Richard H. Tuck, MD, FAAP, provided information for this article. All are members of the American Academy of Pediatrics (AAP) coding and reimbursement committee. In addition, Schulte is the AAP CPT advisor.